Preventing neurocognitive late effects in childhood cancer survivors.
Neurocognitive late effects are common sequelae of cancer in children, especially in those who have undergone treatment for brain tumors or in those receiving prophylactic cranial radiation therapy to treat leukemia. Neurocognitive morbidity in attention, executive functioning, processing speed, working memory, and memory frequently occurs and contributes to declines in intellectual and academic abilities. Oncologists are faced with the challenge of using the most effective, often the most intense, therapy to achieve the primary goal of medical success, balanced with the desire to prevent adverse late effects. Not all children with similar diagnoses and treatment have identical neurocognitive outcomes; some do very poorly and some do well. Attention now turns to the reliable prediction of risk for poor outcomes and then, using risk-adapted therapy, to preserve neurocognitive function. Prevention of late effects through rehabilitative strategies, continuation of school, and pharmacotherapy will be explored.
Askins
Martha A
MA
Department of Pediatrics, Children's Cancer Hospital, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
Moore
Bartlett D
BD
D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D001921:Brain / Q000187:drug effects* / Q000503:physiopathology / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D002648:Child; D003072:Cognition Disorders / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control*; D004358:Drug Therapy / Q000379:methods / Q000639:trends; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D009413:Nerve Fibers, Myelinated / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods / Q000639:trends; D013995:Time